Matthew Amster/Collins Hotel Associates, LLC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedsion, recommendation of the
Oty Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire dedsion-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically indudes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Matthew Amster
TELEPHONE NUMBER:
FAX NUMBER:
(M.I)
suite Mia,FL 33131
(State) (Zip Code)
~amster@brzoninglaw.com
EMAIL:
NAME OF LOBBYIST: (Last) (First)
Bercow & Radell 200 S. Biscayne Blvd.,
BUSINESS NAME AND ADDRESS (Number and Street) (Oty)
305-377-6236 305-377-6222
L LOBBYIST RETAINED BY:
Collins Hotel Associates, LLC
NAME OF PRINCPAL./CUENT:
Collins Hotel Associates, LLC 475 Tenth Ave., 11 floor, NY,NY
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code) 1 0 0 1 8
212-277-4184
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
NAME OF O!IEF OFFICER, PARTNER, OR BENEFICIARY:
Marc Gordon, Executive Vice President
. .lDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUOi
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEOFIC LOBBY ISSUE: Application for certificate of appropriateness
for property located at 1690 Collins Ave and 1685 James Ave.
Issue to be lobbied (Describe in detail):
m. CITY AGENOES/INOMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any financial, Familial or Professional Relationship
Thomas Mooney none
William Carey none
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$155.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $1 55. 00 per hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes IiNo: Are YOU lobbyina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes d{No: Are YOU lobbyina on a oendina aoolication for a Deyelooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
DYes aNo: Are YOU reoresentina a not-for-orofit corooration or entity without soecial comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~~~
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
1I#!fjf~ ~
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced 10
GRACE G. CHEN
D Produced 10 NOTARY PUBLIC. STATE OF NEW YOr
Form of Identification NO. 01-cH6056883
CL QUALIFIED IN QUEENS COUNTY
~sonally known (PrinciptM){ COMMI~SION EXPlRES 04-O2-20.0l
Form of Identification
~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworo..a,ns:! subscribed efore me {
This ~ay of ~ 20.Q b
Signatur u IC Notary - State of""Florie.. ~ 4:Nt-
Notarization of Principal's signature
FOR ObERK'S Ugs ONLY
Annual Registration fee: [ ] Yes [ ] No Amount pai~ ./ MCR # ~132..
Lobbyist Registration Form received and verified ~ Q.I
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM .aoc
Date Paid :th-.~
Revised 12/08/04